title: Improved graft survival for flow cytometry and antihuman globulin crossmatch-negative retransplant recipients.
abstract: We compared our standard NIH (extended incubation) crossmatch (XM) with antihuman globulin (AHG) and flow cytometry XMs and correlated the results with rejection episodes and graft survivals. For 89 CsA-Pred, primary renal allograft recipients, AHG and/or FCXM results did not improve on the NIH-XM-negative (NEG) graft survival results, whether testing pretransplant or historical (Hx) sera. Similarly, there was no association of a positive (POS) AHG or FCXM with increased rejection episodes in these primary recipients. However, for retransplant (Re-Tx) recipients a neg AHG or FCXM did discriminate fewer rejections and an improved graft survival compared with the NIH-XM-neg. results. The overall one-year graft survival for the 47 Re-Tx recipients studied herein was 66% (based on a neg pre-Tx NIH-XM). Pre-Tx AHG-NEG, Re-Tx recipients displayed an improved graft survival compared with NIH-XM NEG recipients (77% vs. 66%, P less than 0.05) and with AHG-POS recipients (77% vs. 47%, P less than 0.05). Similarly, pre-Tx, FCXM-NEG, Re-Tx recipients displayed improved graft survivals compared with NIH-XM-NEG recipients (83% vs. 66%, P less than 0.05) and FCXM-POS recipients (83% vs. 48%, P less than 0.05). Re-Tx recipients displaying a POS AHG and/or FCXM experienced a significantly greater number of rejections than NEG-XM recipients (P less than 0.05, respectively). The AHG and FCXM results correlated with rejections and graft survivals whether testing pre-Tx or Hx high-PRA sera. Re-Tx recipients who were AHG-XM-NEG but FCXM-POS, experienced more rejection episodes than recipients who displayed a negative XM reactivity for both AHG and FCXM (P less than 0.02), but with no resulting differences in graft survival. HLA matching, pre-Tx blood transfusions and PRA did not impact on these crossmatch and graft survival results. Use of AHG and/or FCXMs for Re-Tx, but not primary, recipients should help to improve graft survival for these high-risk recipients.
authors.affiliation: Department of Surgery, University of Texas Medical School, Houston 77030.
authors.forename: R H
authors.initials: RH
authors.lastname: Kerman
authors.forename: C T
authors.initials: CT
authors.lastname: Van Buren
authors.forename: R M
authors.initials: RM
authors.lastname: Lewis
authors.forename: V
authors.initials: V
authors.lastname: DeVera
authors.forename: V
authors.initials: V
authors.lastname: Baghdahsarian
authors.forename: K
authors.initials: K
authors.lastname: Gerolami
authors.forename: B D
authors.initials: BD
authors.lastname: Kahan
mesh_terms: D000888:Antibodies, Anti-Idiotypic / Q000032:analysis*; D005434:Flow Cytometry; D006085:Graft Survival; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D012086:Reoperation
chemical_list: D000888:Antibodies, Anti-Idiotypic